Individual
EVAN L DAVIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
901 W MORTON AVE, SUITE 16A, JACKSONVILLE, IL 62650-3146
(217) 245-4640
(217) 245-4642
Mailing address
3705 SWITCHGRASS CT, SPRINGFIELD, IL 62712-5878
(217) 523-7590
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WASHINGTON UNIV
SCHOOL
—
Enumeration date
03/25/2006
Last updated
07/08/2007
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